避孕选择与生育健康——湖南省农村妇女生育健康调查报告之一

1 引言 自70年代后期广泛开展计划生育工作以来,中国育龄夫妇的避孕使用率及避孕方法构成均发生了显著变化。据国家计生委1982、1988、1992年三次大规模生育率抽样调查的结果,在全国水平上,有偶育龄妇女(1982,1988)或已婚育龄妇女(1992)的避孕率分别为70.9％、72.1％和83.5％,后者已达到世界高避孕率地区北欧国家的水平。与此同时,绝育法的比例由35.4％上升到53.5％,避孕环的比例由50.1％下降到40.1％,而采取“其它”方法(口服、注射及外用避孕药、避孕套、传统避孕法等)的比例由14.5％下降到6.4％。可以说,高避孕使用率及高绝育比例构成了现阶段中国育龄夫妇避孕状况的基本特征。     

中国已婚育龄人口避孕行为的转变:1988～2001年

文章利用中国1988年和2001年生殖/节育调查数据,运用多元Logit模型,深入分析了此期间已婚育龄人口避孕选择模式的变化、区域差异及其决定因素。结果表明,在1988~2001年间,避孕选择始终是以男女性绝育和宫内节育器为主,已婚育龄人口文化程度越高,选择宫内节育器的可能性越大,反之选择男女性绝育的可能性大;农村选择男女性绝育的可能性增大,城镇选择宫内节育器的可能性增大;选择避孕套的可能性增大;东、中、西部的变化趋势一致,但幅度差异显著。这与中国育龄人口的避孕节育意愿有较大的趋同性和稳定性,其差异很可能与计划生育服务质量有关。     

我国农村育龄夫妇避孕使用及模式的影响因素分析

本文根据1992年国家计生委在全国进行的“计划生育管理信息系统首次调查”的数据,运用带Huber方差校正和多项分类的Logit模型,对我国农村育龄妇女避孕使用水平及模式的影响因素进行了分析。结果表明,育龄妇女的避孕使用水平随年龄、婚后年数、教育程度和现有子女数的增加而升高,社区的社会经济水平和计划生育工作水平越高,避孕使用水平也越高;最小子女为女孩、少数民族地区的育龄妇女的避孕使用水平显著较低。在避孕模式的选择上,相对于无措施而言,经济较发达的地区,绝育措施的使用显著较低,现有子女数、计划生育服务和工作力度可使绝育使用增加,但发现育龄妇女的文化程度对绝育无影响,居住在平原或丘陵地区的育龄妇女的各种措施使用水平均较高,在控制了其它措施的使用后,男、女绝育水平对比分析发现,经济较发达的地区和社区经济状况较好的社区中,男性绝育的使用低于女性绝育,并发现距计划生育服务越近男性绝育水平越高。此外,本文显示,育龄妇女的个体特征对男性绝育的影响不大。     

避孕选择:各国家庭计划的可获性

避孕选择：各国家庭计划的可获性〔人口行动国际〕表１发达国家避孕选择指数（现代避孕方法的可获性）国家和地区１９９６年可获性分数避孕套口服避孕药宫内节育器避孕针女性绝育男性绝育避孕选择指数等级德国新西兰西班牙瑞典瑞士２０．０２０．０２０．０２０．０２０．...     

流动人口的避孕节育及影响因素分析

本文利用"流动人口的婚姻家庭调查研究"课题的调查数据,分个人背景、流动经历、婚育状态、配偶背景等几方面对流动人口的避孕知识了解状况、避孕知识获取渠道以及避孕措施实施状况进行描述分析、对比分析和多因素影响分析,并建立多分类有序logistic模型对流动人口避孕知识水平的影响因素进行多元回归分析.研究结果表明,流动人口总体避孕知识水平一般,受教育程度、流动经历、职业、孩子数量、避孕措施实施等方面是流动人口避孕知识状况的主要影响因素.     

中国生殖健康方案的推进和已婚育龄人口避孕模式转变——ICPD 10:避孕方法的医控模式和自控模式有变化吗

避孕节育是生殖健康极为重要的内容。文章利用国家人口和计划生育委员会1988年至2001年全国生育节育抽样调查和全国计划生育/生殖健康调查数据,分析了已婚育龄人口在避孕模式上的时空变化特征,在此基础上进一步研究了在已婚育龄人口的年龄、子女数和生活的不同区域环境等方面避孕模式的时空变化。结果表明,在我国人口转变的过程中,低生育水平下的避孕模式以及推行避孕节育知情选择后已婚育龄人口的避孕模式,特别是医院控制的避孕方法与自己控制的避孕方法的构成已经发生了变化,有必要进一步改善生殖健康服务的技术服务等。     

影响女性绝育的因素分析

女性绝育是一种安全、可靠、永久性的避孕方法。我国是在1939年开始把输卵管绝育工作作为一种避孕手段实施的,但是在50年代末期以前使用的人数极为有限。在1979年我国政府提出“一对夫妇只生一个孩子”的号召。计划生育工作作为我国的基本国策深入到穷乡僻壤,采用绝育的人数迅猛增加。在各种避孕方法中女性绝育占38.24％,仅次于IUD(41.48％),成为我国育龄妇女最主要的避孕方法之一。绝育对于控制我国人口增长来说,已起到举足轻重的作用。为此确切弄清楚女性绝育妇女的社会、人口学特征,找出影响绝育的主要因素,对于进一步有效开展计划生育工作具有十分重要的现实意义。 1 资料和方法 本研究资料取自1988年中国2‰人口生育、节育抽样调查10％的资料,其中在调查时20—49岁已婚妇女39525人,已采用女性绝育方法(输卵管结扎、输卵管粘堵、输卵管栓堵、输卵管银夹)的妇女10878人。     

避孕方法知情选择影响因素的干预分层解析

国际经验表明,全球范围内的避孕方法知情选择在现实与理想之间仍存在一定的差距。文章按照干预实施的需要,运用文献回顾和数据资料从个体/社区、服务提供以及政策措施三个层面剖析我国开展避孕方法知情选择的影响因素。结果显示:首先,我国的相关法律、法规和政策对避孕方法知情选择既有有利的因素也有不利的因素;第二,在服务提供层面,管理人员对避孕方法知情选择的认识有误或认识不足严重阻碍了当地知情选择的开展;第三,社区/家庭等个人密切接触的小环境容易被忽视,这一层次的因素应予以充分重视和足够关注。基于以上认识,提出了开展避孕方法知情选择的干预策略。     

2011-2017年中国流动人口避孕模式变化分析

近年来我国生育政策经历了重大调整,其对生育的影响受到广泛关注。避孕是生育的中间变量,通过对避孕模式变化的深入探究可洞察人群生育取向的变化趋势。流动人口中育龄人口比重大,避孕方法使用率高,可能有较为明显的政策效果辨识度。文章利用2011-2017年全国流动人口动态监测调查数据,通过交叉分类的分层结构年龄-时期-队列模型(HAPC-CCREM)解决一般线性模型的共线性问题,探讨流动育龄妇女是否采用不可逆避孕方法的影响因素并描述其动态变化。研究不仅探讨个体层面、家庭层面和区域(主要从政策角度)层面因素对流动妇女避孕模式的影响,更重要的是考察了可能存在的时期与队列效应,即政策效应及作用人群。研究发现中国流动育龄妇女采取不可逆避孕比例随年龄下降而减少;不同出生队列避孕方法选择存在差异,受计划生育政策影响较大的1976-1984年的出生队列更倾向采用不可逆避孕措施,而年轻队列主要使用短效避孕方法;时期因素对流动人口避孕方法选择的效应最为明显,主要体现在生育政策调整后不可逆避孕的使用率大大降低,对未生育的或已育一孩的流动妇女的避孕模式有显著影响,子女性别构成在短期内并没有改变性别偏好对避孕行为的影响。研究结果表明流动人口避孕方式的改变是长期趋势性因素影响的结果,生育政策的调整对其有深刻影响。     

男性避孕方法在中国的宣传和推广

作为男性避孕方法之一的避孕套在中国育龄人群中的使用率始终在 5 %左右。艾滋病和性别在中国已呈上升发展趋势 ,在人群中宣传和促进使用这种方法可以起到良好的避孕防病的作用。本文通过检索已有的相关文献 ,研究和分析了避孕套在我国的出现、宣传和推广使用的过程。发现这一方法从国外传入我国的时间不长 ;推广这种方法的人群在扩大、倡导的方式也在不断变化 ;法律法规的引导以及政府相关部门的介入与协作对宣传使用这种方法具有积极作用     

Low fertility and limited diffusion of modern contraception in Italy during the second half of the twentieth century

During the last two decades of the twentieth century, Italy, Greece, Spain, Portugal, and Japan were characterized by very low fertility levels and limited diffusion of the pill, IUD and sterilization for contraceptive purposes. This paradox is discussed for Italy by revisiting the history of contraception and reproduction during the second half of the twentieth century, and by using new data for the end of that century and the early twenty-first century. The main results are: (1) it has been possible to maintain low rates of planned and unplanned fertility without resorting to more effective contraceptive methods thanks to a careful use ofcoitus interruptus; (2) the pace of diffusion of the pill and IUD was so slow because of the opposition to contraception of the Catholic Church, a gender system emphasizing traditional male and female roles, and a medical culture that made physicians reluctant to prescribe the pill for their patients; and (3) the contraceptive patterns of Italian women born after 1960 are more similar to those of their Western counterparts, although new peculiarities appear, for example, substantial reliance on the condom by people living as couples as well as sexually active singles.     

The role of contraceptive supply and demand in Mexican fertility decline: evidence from a microdemographic study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.     

The Role of Contraceptive Supply and Demand in Mexican Fertility Decline: Evidence from a Microdemographic Study

This paper uses retrospective life history data to assess the impact of family planning services on contraceptive use in a rural Mexican township. Between 1960 and 1990 contraceptive use rose and fertility declined dramatically. Both contraceptive supply and demand factors were influential in these trends. The start of the government-sponsored family planning programme in the late 1970s was associated with a sharp rise in female sterilization and use of the IUD. However, once we controlled for the changing socio-economic and demographic characteristics of the sample, the presence of family planning services had no significant effect on the likelihood that women used modern reversible methods compared to traditional methods. Men and women expressed concerns about the safety of modern methods such as the pill and the IUD. Efforts to increase modern contraceptive use should place greater emphasis on communicating the safety of these methods and improving the quality of services.     

The trends of contraceptives of people in Shanghai since early 1980s

Shanghai has had the lowest fertility rate in China for many years. Shanghai had a negative rate of natural growth during 1990-95. During 1980-93, fertility dropped continuously. In 1982, contraceptive use among married women included 29.47% using IUDs, 29.33% using oral pills, 23.44% using female sterilization, and 10.48% using condoms. Contraceptive prevalence declined slightly from 98.6% in 1982 to 92.29% in 1993. By 1993, method use changed. Oral pill and female sterilization use declined to 8.04% and 7.22%, respectively, among married women of reproductive age. IUD use increased dramatically to 72.2% in 1993. Condom use declined to 8.83% of total users. Despite reduced contraceptive prevalence, the birth rate declined from 18.51/1000 population in 1982 to 6.50/1000 population in 1993. The proportion of women accepting the one-child certificate increased from 53.32% of all married women of reproductive age in 1984 to 70.13% in 1993. The shift use of contraceptive methods means reliance on long-term reversible methods.     

'Continuation rate', 'use-effectiveness' and their assessment for the diaphragm and jelly method

Abstract The application of the life-table technique in the calculation of use-effectiveness of a contraceptive was proposed by Potter in 1963.(1) The technique was also found to be useful in assessing the duration for which the use of a contraceptive was continued. The keen interest that existed in the use of IUD in the mid-1960's was reflected in the terminology developed for assessment of the continuity of use. 'Retention rate' was a frequently used index.(2) Because of the development of the concept of segments whose end-period determined either termination of the use of a method or its continuance on a cut-off date, 'closure rate' and 'termination rate' have been used as measures of the discontinuance of the use of methods primarily of the IUD.(3) While discussing concepts relating to acceptance, use and effectiveness of family planning methods, more generally, an expert group suggested that 'continuation' should be used to denote that a client (or a couple) had begun to practise a method and that the method was still being practised.(4) Since this group defined 'an acceptor' as a person taking service and/or advice, i.e. having an IUD insertion or a sterilization operation or receiving supplies (or advice on methods such as 'rhythm' or coitus-interruptus with the intent of using the method), the base for the assessment of continuation rates, according to this group, would be only those acceptors who had begun using the method. The lifetable method has also been used for the study of the continuation rate for pill acceptors.(5) Balakrishnan, et al., made a study of continuation rates of oral contraceptives using the multiple decrement life-table technique.(6).     

Contraceptive sterilization in the U. S.: 1965 and 1970

There was an impressive increase between 1965 and 1970 in the prevalence of contraceptive sterilization, an increase that accelerated in the later years of the period and was shared in by virtually all subgroups considered. Among couples in 1970 for whom sterilization had been an option (recognizing that it is a terminal method), about one of every five had chosen this method of contraception. About half of all sterilizations were vasectomies, though vasectomies have outnumbered tubal ligations in recent years. Differentials in prevalence and in increases during 1965–1970 are reported for a number of life-cycle and social variables. In addition, a profile of the contraceptive sterile is presented for recent sterilizations. Significant proportions are relatively young and of low parity at the time of sterilization. In the context of the continued diffusion of the pill and IUD and increases in legal abortion, the net demographic effect of increasing sterilization is regarded as low, though sterilization is an important component of an effective fertility control regime.     

Choosing a contraceptive method: why does it matter?

The use of contraceptives varies widely among Asian countries. Based on the most recent survey data available, the rate varies from nearly 8/10 married women aged 15-44 in Taiwan to fewer than 1/10 in Pakistan and Nepal. Women in East Asian countries are most likely to practice contraception, followed by those in Southeast Asia, with lower contraceptive prevalence rates found in South Asia. The rates of some East Asian nations now match those of the US and other developed nations, while in most South Asian nations contraception is spreading slowly. Contraceptive methods in use vary widely by country. The leading method in the greatest number of countries is sterilization, but in most countries several methods are nearly equal in popularity. Only in India is sterilization used by a majority of those people who practice contraception. Japan is the only country in which a majority of contraceptors use condoms, and only in China do 1/2 use IUDs. The choice of a particular contraceptive method is strongly influenced by 1) methods available through family planning programs, or promoted through the use of target systems; 2) religous and cultural factors; 3) concerns about side effects and safety; 4) ease of access to particular methods; 5) the medical profession; and 6) legality--in Japan the pill is illegal. In most countries the type of contraceptive that people prefer has changed since the introduction and promotion of modern methods of contraception. In general, there has been a shift to more effective methods. An increase in female sterilization at the expense of other methods such as the IUD or pill is the most common pattern. In countries where female sterilization is unpopular, use of such modern methods as the pill, IUD, or condom has increased at the expense of traditional methods.     

Sterilization and IUD target achieved

Voluntary acceptance of permanent contraceptive methods showed an upward trend in Bangladesh over the past 5 months. 62,399 sterilizations were performed in October, 1983, a 98% realization of the monthly target. 70,618 sterilizations were performed in November, 1983, a 111% achievement. IUD acceptors in October totaled 22,004, a 142% achievement, and the figure was 24,324 in November, a 157% achievement of the monthly target. In October 1982 the total number of sterilization acceptors was 54,705; the figure was 9802 for IUD acceptors. In November 35,485 persons accepted sterilization and 9682 accepted IUDs.     

Understanding U.S. fertility: findings from the National Survey of Family Growth,Cycle III

The 1st overview of findings from Cycle III of the National Survey of Family Growth, the latest of 7 such surveys of US fertility since 1955 and the 1st to cover all women of childbearing age in the conterminous US is presented. Interviews between August 1982 and February 1983 with 7969 women, representative of 54 million women aged 15-44, reveal that sterilization is now the leading contraceptive method in the US, used by 33% of all contraceptors in 1982 (22%, female sterilization; 11% male sterilization), followed by the pill (29%), condom (12%), diaphragm (8%), and IUD (7%). Linked to this is the continuing decline in unwanted births since the baby boom peak in 1957, which accounted for nearly 1/2 of the drop between 1973 and 1982 in ever-married women's children ever born, from 2.2 to 1.9/woman. However, births conceived sooner than planned increased slightly among younger married women, probably due to the large drop in pill use since 1973 and increased use of the less effective diaphragm and condom among couples still intending to have more children. Black women are now more likely than white women to use the most effective female methods: female sterilization, pill, and IUD. Only 45% of women aged 15-44 in 1982 had used a contraceptive method at 1st intercourse. 4 out of 5 women married for the 1st time between 1975 and 1982 had intercourse before marriage. However, premarital sexual activity may be leveling off among white teenagers after a steep rise since the early 1970s and declining moderately among black teenagers. 16% of 1st marriages among ever-married women aged 15-44 in 1982 had been dissoved within 5 years, mostly by divorce or separation. 59% of black women with children in 1982 had their 1st birth before marriage, compared to 11% of white mothers. The proportion of babies who were breastfed more than doubled between 1970-71 and 1980-81, from 24 to 53%.     

Birth control techniques in China

This article describes the major birth control techniques in use in China, based on data from a contraceptive prevalence study conducted in September, 1982. 118 million of the 170 million married women of child bearing age use birth control. IUD insertion accounts for 50.2% of birth control methods used, tubal ligation accounts for 25.4%, vas deferens ligation 10.0% oral contraceptives (OCs) 8.2%, and condoms 2.0%. A table of clinical data on 9 China made IUDs reveals that pregnancy rates range from 0 (V Cu-300 model) to 5.83% (mixed ring model). A method of IUD insertion immediately after delivery has been researched and adopted, using a silastic Delta IUD with barium added to reduce the high postpartum expulsion rate. fixing the IUD by sutures during Cesarean section has also been developed. Electronmicroscopic studies of the endometrium of women who have used a stainless steel IUD for more than 20 years showes no tendency towards malignancy, nor negative effects on the endocrine functions of the ovaries. 28 million Chinese women have accepted sterilization as of June, 1982. Local anesthesia and the use of acupuncture have reduced complications due to general anesthesia seen previously. Sterilization by means of chemically induced adhesion of Fallopian tube tissue has also been performed successfully; however, this method makes later anastomosis difficult, and is not suitable for young women with only 1 child. Fallopian tube occlusion by means of a silver clip has been performed in 1,128 cases, with a pregnancy rate of only .85%. 10.62 million men have accepted sterilization. While most of the procedures are val ligations, 300,000 men have been sterilized by direct injection of an adhesive agent throuh the skin of the scrotum. No increase in auto immune or vascular disease has been found. 3 low-dose OCs, used since 1969, have proven to be reliable and freer of side effects than higher-dose compounds. In addition, longterm OCs containing quinestrol have been used since 1969 with a success rate of 98.3% women-year. These pills are taken 1x monthly. R and D priority will be given be given to monthly injectable contraceptives; megestrol and norethindrone are the compounds most preferable. In trials so far, the effective rate has been 99.9% with mild side effects. Gossypol, a male contraceptive, has shown an antifertility effect in 99% of 8000 cases studied; however, hypokalemia and irreversibility of spermatogenesis were reported in some cases. Vacuum suction is the most common method for abortion, but Radix Trichosanthis and lilac daphne terpine, traditional abortifacients, anre acceptable for 1st trimester abortions. Prostaglandins are also used.